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Lax Y, Keller K, Silver M, Safadi BM, Hwang EK, Avner JR. The Use of Telemedicine for Screening and Addressing Social Needs in a Primary Care Pediatric Population in Brooklyn, New York. J Community Health 2024; 49:46-51. [PMID: 37405613 DOI: 10.1007/s10900-023-01254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
The objective of this study was to analyze temporal changes in social needs (SN), comparing those who received routine annual in-person care to those receiving SN screenings through a combination of tele-social care and in-person care biannually. Our prospective cohort study used a convenience sample of patients from primary care practices. Baseline data were collected from April 2019 to March 2020. The intervention group (n = 336) received SN screening and referral telephone outreach from June 2020 to August 2021. The control group (n = 2890) was screened, in person, during routine visits at baseline and summer 2021. We used a repeated-measures logistic regression with general estimating equations to assess incremental change in individual SN for the intervention group. Food, housing, legal and benefit needs increased and peaked at the beginning of the pandemic and decreased after interventions (P < 0.001). There was a 32% decrease in the odds of food insecurity for those in the intervention group compared to the control group (adjusted OR 0.668, 95% confidence interval 0.444-1.004, P = 0.052), and a 75% decrease in the odds of housing insecurity (adjusted OR 0.247, 95% confidence interval 0.150-0.505, P < 0.001). During COVID-19, there was an increase in SN followed by a decrease after interventions were offered. Those who completed tele-social care showed greater improvements in social needs than those in routine care, with the greatest improvements in food and housing needs.
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Affiliation(s)
- Yonit Lax
- Department of Pediatrics, Maimonides Medical Center, 1301 57th Street, Brooklyn, NY, 11219, USA.
- SUNY Downstate Health Sciences University Brooklyn, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Kim Keller
- Department of Pediatrics, Maimonides Medical Center, 1301 57th Street, Brooklyn, NY, 11219, USA
| | - Michael Silver
- Biostatistics, Maimonides Medical Center, 1301 57th Street, Brooklyn, NY, 11219, USA
| | - Bryant Muniz Safadi
- SUNY Downstate Health Sciences University Brooklyn, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Eun Kyeong Hwang
- SUNY Downstate Health Sciences University Brooklyn, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Jeffrey R Avner
- Department of Pediatrics, Maimonides Medical Center, 1301 57th Street, Brooklyn, NY, 11219, USA
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Zhang Q, Silver M, Chen YJ, Wolf J, Hayek J, Alagkiozidis I. Comparison of Minimally Invasive Surgery with Open Surgery for Type II Endometrial Cancer: An Analysis of the National Cancer Database. Healthcare (Basel) 2023; 11:3122. [PMID: 38132012 PMCID: PMC10743283 DOI: 10.3390/healthcare11243122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Prior studies comparing minimally invasive surgery with open surgery among patients with endometrial cancer have reported similar survival outcomes and improved perioperative outcomes with minimally invasive surgery (MIS). However, patients with Type II endometrial cancer were underrepresented in these studies. We sought to compare the overall survival and surgical outcomes between open surgery and MIS in a large cohort of women with Type II endometrial cancer. METHODS Using data from the National Cancer Database, we identified a cohort of women who underwent hysterectomy for type II endometrial cancer (serous, clear cell, and carcinosarcoma) between January 2010 and December 2014. The primary outcome was a comparison of the overall survival for MIS with that for the open approach. The secondary outcomes included a comparison of the length of hospital stay, readmission within 30 days of discharge, and 30- and 90-day mortality. Outcomes were compared between the cohorts using the Mann-Whitney U test, Pearson's chi-square test, or Fisher's exact test. Multivariable logistic regression with inverse propensity weighting was used to determine clinical characteristics that were statistically significant predictors of outcomes. p values < 0.05 were considered significant. RESULTS We identified 12,905 patients with Type II, Stage I-III endometrial cancer that underwent a hysterectomy. In total, 7123 of these women (55.2%) underwent MIS. The rate of MIS increased from 39% to 64% over four years. Women who underwent MIS were more often White, privately insured, older, and had a higher income. The laparotomy group had a higher rate of carcinosarcoma histology (30.9% vs. 23.6%, p < 0.001), stage III disease (38.4% vs. 27.4%, p < 0.001), and larger primary tumors (59 vs. 45 mm, p < 0.001). Lymph node dissection was more commonly performed in the MIS group (89.6% vs. 85.4%, p < 0.001). With regard to adjuvant therapy, subjection to postoperative radiation was more common in the MIS group (37% vs. 40.1%, p < 0.001), while chemotherapy was more common in the laparotomy group (37.6% vs. 33.9%, p < 0.001). The time interval between surgery and the initiation of chemotherapy was shorter in the MIS group (39 vs. 42 days, p < 0.001). According to the results of propensity-score-weighted analysis, MIS was associated with superior overall survival (101.7 vs. 86.7 months, p = 0.0003 determined using the long-rank test), which corresponded to a 10% decreased risk of all-cause mortality (HR 0.9; CI 0.857-0.954, p = 0.0002). The survival benefit was uniform across all three histology types and stages. MIS was associated with superior perioperative outcomes, including shorter length of stay (1 vs. 4 days, p < 0.001), lower 30-day readmission rates (2.5% vs. 5%), and lower 30- and 90-day postoperative mortality (0.5% vs. 1.3% and 1.5% vs. 3.6%, respectively; p < 0.001 for both). The increased adoption of MIS from 2010 to 2014 corresponds to a decrease in 90-day postoperative mortality (2.8% to 2.2%, r = -0.89; p = 0.04) and overall mortality (51% to 38%, r = -0.95; p = 0.006). CONCLUSIONS In a large cohort of patients from the National Cancer Database, MIS was associated with improved overall survival and superior perioperative outcomes compared to open surgery among women with Type II endometrial cancer. A decrease in postoperative mortality and a shorter interval between surgery and the initiation of chemotherapy may contribute to the survival benefit of MIS. A racial and economic disparity in the surgical management of Type II endometrial cancer was identified, and further investigation is warranted to narrow this gap and improve patient outcomes.
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Affiliation(s)
- Qi Zhang
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Michael Silver
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Yi-Ju Chen
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Jennifer Wolf
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Judy Hayek
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Ioannis Alagkiozidis
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
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Trabilsy M, Roberts A, Ahmed T, Silver M, Manasseh DME, Andaz C, Borgen PI, Feinberg JA. Lack of Racial Diversity in Surgery and Pathology Textbooks Depicting Diseases of the Breast. J Surg Res 2023; 291:677-682. [PMID: 37562229 DOI: 10.1016/j.jss.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The lack of racial diversity depicted in medical education texts may contribute to an implicit racial bias among clinicians. This bias influences outcomes, as familiarity with the various cutaneous manifestations of disease is essential to making an accurate diagnosis. To better understand the racial disparities in breast surgery, we sought to determine the extent of skin tone representation depicted in images of breast surgery and pathology textbooks. METHODS Textbooks were screened for color images of conditions with sufficient skin tissue present to assign the Fitzpatrick skin phototype (FSP). Figures were independently assigned an FP score (range: 1-6), and subdivided into "light skin" (FP 1-3) and "dark skin" (FP 4-6). Number of figures in each category and percentage of patients with each skin tone were calculated. RESULTS 557 figures were included. Among 12 textbooks reviewed, seven textbooks were from the discipline of surgery, while five were pathology-related. Textbook year of publication spanned from 1996 to 2018. Overall, 533 (95.7%) figures depicted patients with light skin color versus 24 (4.3%) with dark skin color. There was no association between FP score and year of textbook publication (P = 0.69). CONCLUSIONS Patient images in breast textbooks are overwhelmingly of light skin tones, excluding patients with darker skin tones. The dearth of images depicting dark skinned individuals did not improve over time. Inclusion of patients of color in future textbooks may help reduce racial disparities within breast cancer care.
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Affiliation(s)
- Maissa Trabilsy
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Arielle Roberts
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Tahina Ahmed
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Michael Silver
- Maimonides Medical Center, Research Administration, Brooklyn, New York
| | | | - Charusheela Andaz
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Patrick I Borgen
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Joshua A Feinberg
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York.
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Abstract
OBJECTIVE The objective of this study was to compare maternal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who underwent cesarean births. STUDY DESIGN This was a matched cohort study of pregnant women who had a cesarean birth between March 15, 2020, and May 20, 2020. Cases included women who tested positive for SARS-CoV-2. For every case, two patients who tested negative for SARS-CoV-2 were matched by maternal age, gestational age, body mass index, primary or repeat cesarean birth, and whether the procedure was scheduled or unscheduled. We compared rates of adverse postcesarean complications (intraoperative bladder or bowel injury, estimated blood loss more than or equal to 1,000 mL, hemoglobin drop more than 3 g/dL, hematocrit drop more than 10%, need for blood transfusion, need for hysterectomy, maternal intensive care unit admission, postoperative fever, and development of surgical site infection), with the primary outcome being a composite of those outcomes. We also assessed duration of postoperative stay. Fisher's exact tests were performed to compare the primary outcome between both groups. RESULTS Between March and May 2020, 202 women who subsequently underwent cesarean birth were tested for SARS-CoV-2. Of those 202, 43 (21.3%) patients were positive. They were matched to 86 patients who tested negative. There was no significant difference in the rate of composite adverse surgical outcomes between the groups (SARS-CoV-2 infected 27.9%, SARS-CoV-2 uninfected 25.6%; p = 0.833). There was a higher rate of postoperative fevers (20.9 vs. 5.8%; p = 0.015), but that did not result in a longer length of stay (p = 0.302). CONCLUSION Pregnant women with SARS-CoV-2 who underwent a cesarean birth did not have an increased risk of adverse surgical outcomes, other than fever, compared with pregnant women without SARS-CoV-2. KEY POINTS · Women with SARS-CoV-2 had more postoperative fevers.. · Length of stay did not differ based on SARS-CoV-2 status.. · Composite postoperative outcome did not differ based on SARS-CoV-2 status..
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Affiliation(s)
- Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Viktoriya London
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | | | - Fouad Atallah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York
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Futterman ID, Gilroy LC, Silver M, Minkoff H, Al-Kouatly HB, McLaren RA. Changes in Rates of Hypertensive Disorders of Pregnancy Among Nulliparous Patients After the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial. Obstet Gynecol 2023; 142:239-241. [PMID: 37473407 DOI: 10.1097/aog.0000000000005239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023]
Abstract
The ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial demonstrated lower rates of hypertensive disorders of pregnancy (HDP) among low-risk nulliparous patients undergoing labor induction at 39 weeks of gestation. We conducted a population-based cohort study in which we evaluated the association between the routinization of 39-week induction and the rate of HDP by comparing rates before and after the ARRIVE trial publication, using the National Vital Statistics System. Logistic regression models were used to project what the HDP rate would have been based on trends seen pre-ARRIVE. Despite an overall increase in the rate of HDP from pre-ARRIVE to post-ARRIVE (4.9% pre vs 6.3% post, adjusted odds ratio [aOR] 1.26, 95% CI 1.24-1.27), the HDP rate was significantly lower in the post-ARRIVE group among patients undergoing induction at 39 weeks of gestation (14.7% pre vs 14.1% post, aOR 0.91, 95% CI 0.90-0.93), decreasing by 12.0% per year (P<.001). The rate of HDP among all other delivering patients was higher in the post-ARRIVE group (4.1% pre vs 5.5% post, aOR1.32, 95% CI 1.30-1.34). Our findings may suggest that, as the overall HDP rate rises, the relative advantage of 39-week induction will rise similarly.
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Affiliation(s)
- Itamar D Futterman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Research Administration, Maimonides Medical Center, Brooklyn, New York; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Guernsey DT, Slobod E, Silver M, Cohen L, Ali A, Toure A, Zerzan J. The aftermath of the COVID-19 pandemic on pediatric mental health: A pediatric emergency department's perspective. Am J Emerg Med 2023; 71:95-98. [PMID: 37354895 PMCID: PMC10268946 DOI: 10.1016/j.ajem.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Pediatric mental health visits in the United States has become a public health crisis. Pediatric emergency departments (PED) encounter these patients during mental health emergencies. The COVID-19 pandemic disrupted the social environment of pediatric patients which potentially lead to new and worsening mental health issues. This study examined the proportion of mental health visits to PED around the first wave of the COVID-19 pandemic. METHODS This retrospective cohort study assessed the proportion of mental health visits at a urban, PED between September 2019 to February 2022. Inclusion criteria were subjects aged 6 to 18 years with a holding order assigned, and one of identified mental health International Classification of Disease, Tenth Division (ICD-10) codes: F01-F99, T14.19, R45, R46.89. Proportion of mental health visits were compared in 6-month periods with the first 6-months representing the pre-COVID-19 period. Secondary analysis compared demographic information and ICD-10 codes. RESULTS A total of 1036 charts were studied: 126 charts from 2019 to 2020, 512 from 2020 to 2021, and 398 from 2021 to 2022. The proportion of mental health visits from September 2019 to February 2020 was 1.4%, and for the following 6-month periods, the proportion of mental health visits was 1.2%, 7.5%, 4.9%, and 5.7%. There was a statistically significant difference (p < 0.001) demonstrating a higher proportion of mental health visits after the start of the COVID-19 pandemic. Secondary analysis demonstrated statistically significant difference in both median age (p < 0.001) and median length of hospitalization (p < 0.001). CONCLUSION This study demonstrated a significant increase in pediatric mental health visits following the start of the COVID-19 pandemic. We believe further investigation into the needs and management during acute surges will improve the care we provide to this vulnerable population.
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Affiliation(s)
- David T Guernsey
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Elina Slobod
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lea Cohen
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ayesha Ali
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - April Toure
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jessica Zerzan
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Jivanji D, Shpeen B, Kaplan-Marans E, Neckonoff E, Silver M, Schulman A. Assessing the safety of minimally invasive partial nephrectomy in octogenarians. J Robot Surg 2023:10.1007/s11701-023-01600-3. [PMID: 37067699 DOI: 10.1007/s11701-023-01600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Abstract
As life expectancy continues to rise, there is a growing cohort of octogenarians that can have oncologic benefit from a partial nephrectomy. This study aims to analyze a large national dataset to compare the safety and outcomes in octogenarians receiving a nephrectomy. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized. All subjects 80-89 years old who received a minimally invasive partial nephrectomy (CPT: 50543) or radical nephrectomy (CPT: 50545, 50546) from 2016 to 2020 were included. Baseline characteristics, comorbidities, and postoperative complications were compared. Chi-square analysis and student t-tests were used to analyze categorical and continuous variables, respectively. 1765 procedures were performed on octogenarians, of which 1299 (73.6%) received a radical nephrectomy and 466 (26.4%) received a partial nephrectomy. When comparing preoperative comorbidities, octogenarians undergoing partial nephrectomy had lower rates of dyspnea at exertion (7.3 vs. 10.6%, p = 0.04), COPD (2.8 vs. 5.9%, p = 0.01), and chronic steroid use (1.5 vs. 3.3%, p = 0.04). No statistically significant differences were seen in any minor (Clavien 1/2) or major post-operative complications (Clavien 3/4). Readmissions were higher in those who received a partial nephrectomy (10.5 vs. 6.5%, p = 0.01); however, there were no significant differences in reoperation (2.4 vs. 1.7%, p = 0.36) or mortality (1.3 vs. 1.8%, p = 0.48). Partial nephrectomy is a safe and feasible operation in octogenarians. Preoperative counseling and appropriate patient selection remain imperative.
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Affiliation(s)
- Dhaval Jivanji
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.
| | - Benjamin Shpeen
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Elie Kaplan-Marans
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Emily Neckonoff
- New York Institute of Technology, College of Osteopathic Medicine, New York, NY, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
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Kittipibul V, Fudim M, Molinger J, Silver M, Yaranov D. Relationship Between Blood Volume Measures and Cardiopulmonary Exercise Testing Performance in Advanced Heart Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kittipibul V, Fudim M, Molinger J, Silver M, Yaranov D. Differences in Cardiopulmonary Exercise Performance Between True Anemia and Hemodilution in Patients with Advanced Heart Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kittipibul V, Fudim M, Molinger J, Silver M, Yaranov D. Differences in Pressure-Volume Relationship Between Obese and Non-Obese Patients with Advanced Heart Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Jivanji D, Kaplan-Marans E, West M, Silver D, Silver M, Schulman A. Can men 75 and older safely receive a minimally invasive radical prostatectomy? J Robot Surg 2023:10.1007/s11701-023-01583-1. [PMID: 36952132 DOI: 10.1007/s11701-023-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
Men 75 and older presenting with localized prostate cancer have traditionally not been managed with surgery. Therefore, we compared the morbidity and operative outcomes of radical prostatectomy (RP) in men 75 and older to their younger counterparts. We utilized the American College of Surgeons National Surgical Quality Improvement Program database to gather subjects who received a minimally invasive RP (CPT: 55866) from 2016 to 2020. This cohort was then stratified by age to compare men 18-74 years old and men 75 and older. The preclinical profile, complications, and outcomes were analyzed. Chi-square and Mann-Whitney U test were used to analyze categorical and continuous variables, respectively. Of the 48,485 men identified, 2,009 (4.1%) were ≥ 75 years old. Within the 75 and older cohort, the median age was 76 (IQR: 75-78), the median BMI was 27.3 (IQR: 24.9-29.9), and 1,601 (79.7%) were Caucasian. Men 75 and older had higher rates of Clavien 3 (1.3% vs. 0.8%, p = 0.02) and Clavien 4 (7.8% vs. 5.0%, p < 0.001) complications. Reoperative rates (1.7% vs. 1.1%, p = 0.01), readmission rates (6.5% vs. 4.1%, p < 0.001), and mortality (0.4% vs. 0.1%, p < 0.001) were all higher in men 75 and older. Multivariate analysis shows older age to be a risk factor for readmission (OR 1.58, 95%CI 1.31-1.90). Complications and 30-day outcomes remain within an acceptable range to offer surgery in men 75 and older. Age alone should not disqualify men from receiving a RP, but appropriate patient selection and counseling are necessary.
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Affiliation(s)
- Dhaval Jivanji
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.
| | - Elie Kaplan-Marans
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Michael West
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - David Silver
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
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Lax Y, Cullen D, Silver M, Avner JR. Identifying Nutritional Insecurity Among Families in an Urban Pediatric Practice. JAMA Netw Open 2023; 6:e231709. [PMID: 36877522 PMCID: PMC9989895 DOI: 10.1001/jamanetworkopen.2023.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
This cross-sectional study examines the prevalence of and concordance between self-reported food scarcity and nutritional insecurity in an urban pediatric practice.
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Affiliation(s)
- Yonit Lax
- Maimonides Medical Center, Brooklyn, New York
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Danielle Cullen
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Jeffrey R. Avner
- Maimonides Medical Center, Brooklyn, New York
- SUNY Downstate Health Sciences University, Brooklyn, New York
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Simon SP, Li R, Silver M, Andrade J, Tharian B, Fu L, Villanueva D, Abascal DG, Mayer A, Truong J, Figueroa N, Ghitan M, Chapnick E, Lin YS. Comparative Outcomes of Candida auris Bloodstream Infections: A Multicenter Retrospective Case-Control Study. Clin Infect Dis 2023; 76:e1436-e1443. [PMID: 36062367 DOI: 10.1093/cid/ciac735] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study was performed to compare clinical characteristics and outcomes between patients with bloodstream infections (BSIs) caused by Candida auris and those with BSIs caused by other Candida spp. METHODS A multicenter retrospective case-control study was performed at 3 hospitals in Brooklyn, New York, between 2016 and 2020. The analysis included patients ≥18 years of age who had a positive blood culture for any Candida spp. and were treated empirically with an echinocandin. The primary outcome was the 30-day mortality rate. Secondary outcomes were 14-day clinical failure, 90-day mortality rate, 60-day microbiologic recurrence, and in-hospital mortality rate. RESULTS A total of 196 patients were included in the final analysis, including 83 patients with candidemia caused by C. auris. After inverse propensity adjustment, C. auris BSI was not associated with increased 30-day (adjusted odds ratio, 1.014 [95% confidence interval, .563-1.828]); P = .96) or 90-day (0.863 [.478-1.558]; P = .62) mortality rates. A higher risk for microbiologic recurrence within 60 days of completion of antifungal therapy was observed in patients with C. auris candidemia (adjusted odds ratio, 4.461 [95% confidence interval, 1.033-19.263]; P = .045). CONCLUSIONS C. auris BSIs are not associated with a higher mortality risk than BSIs caused by other Candida spp. The rate of microbiologic recurrence was higher in the C. auris group.
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Affiliation(s)
| | - Rosanna Li
- Maimonides Medical Center, Brooklyn, New York, USA
| | | | | | | | - Lung Fu
- Maimonides Medical Center, Brooklyn, New York, USA
| | | | | | - Ariel Mayer
- Maimonides Medical Center, Brooklyn, New York, USA
| | - James Truong
- The Brooklyn Hospital Center, Brooklyn, New York, USA
| | | | | | | | - Yu Shia Lin
- Maimonides Medical Center, Brooklyn, New York, USA
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14
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Kilic-Berkmen G, Scorr LM, Rosen A, Wu E, Freeman A, Silver M, Hanfelt J, Jinnah HA. Thyroid disease in cervical dystonia. Parkinsonism Relat Disord 2023; 107:105274. [PMID: 36621155 PMCID: PMC10257803 DOI: 10.1016/j.parkreldis.2022.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
There are many possible etiologies for cervical dystonia (CD), but a cause cannot be identified in most cases. Most recent attention has focused on genetic causes, although a few prior studies have highlighted autoimmune mechanisms instead. Because autoimmune disorders frequently co-exist, the current study evaluated the hypothesis that autoimmune disorders might be more common in CD than neurological controls. The frequency of 32 common autoimmune disorders was evaluated using a systematic survey comparing 300 subjects with CD with 391 neurological controls. The frequency of thyroid disease was significantly higher in CD (20%) compared with controls (6%). Regression analyses that accounted for age and sex revealed an odds ratio of 4.5 (95% CI 2.5-8.1, p < 0.001). All other autoimmune disorders occurred with similar frequencies in CD and controls. Although these studies do not establish a mechanistic link between CD and autoimmune disease, they suggest the need for further attention to a potential relationship, and more specifically with thyroid disease.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Laura M Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ami Rosen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ellen Wu
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Alan Freeman
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael Silver
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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15
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Balhotra K, Chahal K, Silver M, Atallah F, Narayanamoorthy S, Minkoff H. COVID-19 Vaccine Hesitancy in an Underrepresented Minority Community. J Community Health 2023; 48:489-495. [PMID: 36692822 PMCID: PMC9872071 DOI: 10.1007/s10900-022-01184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/25/2023]
Abstract
To assess factors influencing acceptability of COVID-19 vaccine in a population of predominantly indigent, minority, pregnant and non-pregnant people of reproductive age. Cross-sectional survey using a modified Health Belief model administered between January 2021 and January 2022 at four hospitals in Brooklyn. Participants included English-speaking reproductive aged persons attending clinics at the participating sites. Descriptive and univariate data analyses were used for analysis. 283 eligible reproductive persons were approached of whom 272 completed the survey (96%). Three quarters said they would take the vaccine under certain circumstances ("as soon as it is ready" [28.6%], "when my doctor recommends it" [21.3%] or "when enough people have received it to know if it works" [25%]), while 25% said they would never take the vaccine. When comparing persons that would take it under certain circumstances to those that never would, the "never" group was significantly more likely to note that, "they would not trust any COVID vaccine" (71.4% vs. 28.5%; p ≤ 0.0001). This greater level of distrust extended to greater distrust of doctors, government, family, newspapers, and media. However, 36% said they would be influenced by their doctor's recommendation. Pregnant participants were significantly more likely to wait until their doctor recommended it (17.6% of pregnant persons compared to 3.7% of non-pregnant p < 0.0001). Despite mistrust and other discouraging factors, many persons, under appropriate circumstances (e.g., reassurance about vaccine safety) may be motivated to take the vaccine. Even those who claimed that they wouldn't take the vaccine under any circumstance may be influenced by their health care providers.
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Affiliation(s)
- Kimen Balhotra
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Kunika Chahal
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- School of Public Health, SUNY Health Sciences, Brooklyn, NY, USA
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16
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Guernsey D, Kostin S, Silver M, Vazquez H, Zerzan J. The evolving relationship between COVID-19 and serious bacterial infection evaluation in febrile neonates. Acta Paediatr 2023. [PMID: 36596467 DOI: 10.1111/apa.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/07/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
AIM The COVID-19 omicron variant surge highlighted the evolving impact of COVID-19. Febrile infants <60 days old are high risk for serious bacterial infections (SBI). This study evaluated the rate of SBI based on COVID-19 infection. METHODS We conducted a retrospective chart review at an urban, academic paediatric emergency department. The study enrolled infants 60 days old or less with documented fever. The primary outcome was SBI diagnosed by blood, urine, and/or cerebrospinal fluid cultures. We compared the rate of SBI between COVID-19 groups with an omicron variant and 29- to 60-day-old subgroup analyses. RESULTS Two hundred and thirty-three (233) infants meet the criteria. The incidence of SBI was 18.7% in the COVID-19 negative and 1.7% in the COVID-19-positive group which is statistically significant (p < 0.001). Omicron subgroup analysis did not achieve statistical significance (p = 0.62) while COVID-19-positive infants 29-60 days old had a statistically significant lower rate of SBI (p = 0.006). CONCLUSION The omicron variant surge provided an additional understanding of the impact of COVID-19 on these high-risk infants. These results can lead to decreased invasive testing and exposure to antibiotics as well as examine the utility of viral testing for risk stratification.
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Affiliation(s)
- David Guernsey
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Shannon Kostin
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, New York, USA
| | - Hector Vazquez
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jessica Zerzan
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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17
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Gilroy L, Futterman I, Silver M, Minkoff H, Al-Kouatly HB, McLaren RA. Race and obstetrical practices for low-risk nulliparous patients after the ARRIVE trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Futterman I, Gilroy L, Silver M, Minkoff H, Al-Kouatly HB, McLaren RA. The effect of the ARRIVE trial on hypertensive disease of pregnancy rates among low-risk primigravidas. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Ibrahim M, Silver M, Jacob T, Meghpara M, Almadani M, Shiferson A, Rhee R, Pu Q. Open conversion after failed endovascular aneurysm repair is increasing and its 30-day mortality is higher than that after primary open repair. J Vasc Surg 2022; 76:1502-1510. [PMID: 35709860 DOI: 10.1016/j.jvs.2022.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/26/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has become the preferred treatment of abdominal aortic aneurysms (AAAs). Recent studies have demonstrated that cases of EVAR failure repair and subsequent open conversion have increased. The aim of the present study was to evaluate the national trend of annual cases and assess the 30-day outcomes of conversion to open repair after failed EVAR compared with primary open repair. METHODS The National Surgical Quality Improvement Program database was queried for relevant Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision, codes to identify patients who had undergone conversion to open repair or primary open repair of nonruptured AAAs from 2009 to 2018. The annual trend of cases was assessed, and the perioperative outcomes of both procedures were compared. Multivariable logistic regression analyses were conducted to identify independent perioperative factors associated with mortality. RESULTS Of the 9635 patients with nonruptured AAAs included in the present analysis, 9250 had undergone primary repair and 385 had required open conversion. During the 10-year period, the annual number of cases of open conversion had steadily increased and that of primary repair had decreased. The incidence of postoperative complications was similar between both groups, except for cardiac arrest, which had occurred more frequently in the open conversion group. The 30-day mortality was higher in the open conversion group than in the primary group (9.6% vs 3.9%; P < .0001). Open conversion was also independently associated with higher odds of death (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.8-2.4; P < .0001). When the average mortality in both groups was compared between the first and last 5 years, no difference was found (open conversion: 9.8% vs 9.5% [P = 1.00]; primary repair: 3.6% vs 4.2% [P = .19]). Other perioperative factors independently associated with mortality included increased age (OR, 1.8; 95% CI, 1.5-2.1; P < .0001), American Society of Anesthesiologists class ≥III (OR, 2.7; 95% CI, 1.1-6.6; P = .029), insulin-dependent diabetes (OR, 2.0; 95% CI, 1.2-3.3; P = .005), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.1-1.8; P = .006), the presence of dyspnea at rest (OR, 3.3; 95% CI, 1.8-6.1; P < .0001), and a high preoperative hematocrit (OR, 0.94; 95% CI, 0.93-0.97; P < .0001). CONCLUSIONS Open conversion to treat nonruptured AAAs after failed EVAR was independently associated with higher mortality. Also, the annual cases of open conversion have continued to increase without any significant changes in postoperative mortality. This highlights the danger of open conversion and stresses the need for better solutions to prevent and manage EVAR failure.
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Affiliation(s)
- Mudathir Ibrahim
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michael Silver
- Division of Biostatistics, Maimonides Medical Center, Brooklyn, NY
| | - Theresa Jacob
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY; Clinical and Translational Research Laboratories, Maimonides Medical Center, Brooklyn, NY
| | - Melissa Meghpara
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Mahmoud Almadani
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | | | - Robert Rhee
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Qinghua Pu
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY.
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20
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Gerges L, Fassassi C, Masoudi A, Correa-Bravo S, Drapkin J, Likourezos A, Hossain R, Butt M, Silver M, Motov S. 304 Oral VTS-Aspirin/Ketamine Versus Oral Ketamine for Emergency Department Patients With Acute Musculoskeletal Pain. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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21
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Abstract
Background and Purpose Skeletal muscle symptoms and elevated creatine kinase (CK) levels have been consistently reported as part of the COVID-19 disease process. Previous studies have yet to show a consistent relationship between CK levels and skeletal muscle symptoms, disease severity, and death from COVID-19. The purpose of this study is to determine whether elevated CK is associated with a COVID-19 course requiring intubation, intensive care, and/or causing death. Secondary objectives: To determine if there is a relationship between elevated CK and (1) skeletal muscle symptoms/signs (2) complications of COVID-19 and (3) other diagnostic laboratory values. Methods This is a retrospective, single center cohort study. Data were collected from March 13, 2020, to May 13, 2020. This study included 289 hospitalized patients with laboratory-confirmed SARS-CoV-2 and measured CK levels during admission. Results Of 289 patients (mean age 68.5 [SD 13.8] years, 145 [50.2%] were men, 262 [90.7%] were African American) with COVID-19, 52 (18.0%) reported myalgia, 92 (31.8%) reported subjective weakness, and 132 (45.7%) had elevated CK levels (defined as greater than 220 U/L). Elevated CK was found to be associated with severity of disease, even when adjusting for inflammatory marker C-reactive protein (initial CK: OR 1.006 [95% CI: 1.002-1.011]; peak CK: OR 1.006 [95% CI: 1.002-1.01]; last CK: 1.009 [95% CI: 1.002-1.016]; q = .04). Creatine kinase was not found to be associated with skeletal muscle symptoms/signs or with other laboratory markers. Conclusions Creatine kinase is of possible clinical significance and may be used as an additional data point in predicting the trajectory of the COVID-19 disease process.
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Affiliation(s)
- Sarah A. Friedman
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Neurology, New York Presbyterian and Weill Cornell Medicine, New York, NY, USA
| | - Zeinab Charmchi
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael Silver
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nuri Jacoby
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jonathan Perk
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Yaacov Anziska
- Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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22
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Gerges L, Fassassi C, Barberan C, Correa S, Davis A, Drapkin J, Likourezos A, Silver M, Hossain R, Motov S. Oral VTS-Aspirin/ketamine versus oral ketamine for emergency department patients with acute musculoskeletal pain. Am J Emerg Med 2022; 58:298-304. [DOI: 10.1016/j.ajem.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/25/2022] Open
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23
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Lax Y, Cuno K, Keller K, Kogan J, Silver M, Avner JR. Social Determinants of Health and Pediatric Mental Health Before and During COVID-19 in New York City Primary Care Pediatrics. Popul Health Manag 2022; 25:186-191. [PMID: 35442791 DOI: 10.1089/pop.2021.0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In March 2020, at the start of the COVID-19 pandemic, New York City instituted a shelter-in-place order, dramatically affecting the area's social and economic landscape. Pediatric primary care practices universally screen for social determinants of health (SDOH) and mental health (MH) needs, providing an opportunity to assess changes in the population's needs during COVID-19. To assess changes in SDOH and MH needs of pediatric families before and during COVID-19, the authors conducted a prospective cohort study of patients seen in the hospital's pediatric primary care practices. Baseline data were collected during well visits from March 1, 2019 to March 1, 2020, and included the following outcome measures: Patient Health Questionnaire (PHQ2) score >0, PHQ9 scores ≥5, pediatric symptom checklist (PSC17) scores ≥15, and SDOH needs. Follow-up pandemic data were collected from June to August 2020. A total of 423 patients (215 [51%] female, 279 [66%] Hispanic, and 248 [59%] primary English speakers) were enrolled in the study. The following SDOH needs significantly increased during COVID-19: food (17%-32%; P < 0.001), legal (19%-30%; P = 0.003), public benefits (4%-13.8%; P < 0.001), and housing (17.2%-26%; P = 0.002). There was no significant change in MH screening results during COVID-19 compared with baseline: positive PHQ2 depression screen (27.9% vs. 34.3%, P = 0.39), positive PHQ9 depression screen (45.5% vs. 64.1%, P = 0.32), or positive PSC17 measuring emotional and behavioral concerns (4.9% vs. 8.2%, P = 0.13). During COVID-19, patients with food, housing, or legal needs had a significantly higher likelihood of having emotional or behavioral difficulties (P < 0.01). Further research is needed to evaluate outcomes in the following months.
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Affiliation(s)
- Yonit Lax
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kate Cuno
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kim Keller
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jonathan Kogan
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Michael Silver
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jeffrey R Avner
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
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24
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Yaranov D, Fudim M, Brewster A, Baird M, Bacon S, Nguyen J, Tang J, Jefferies J, Silver M. Intravascular Volume Derangement and Value of Blood Volume Analysis in Stable Ambulatory Patients with Advanced Heart Failure Supported with Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Son MA, Jiggetts S, Elfeky A, De Amorim Paiva C, Silver M, Herzog D, Saraf S, Bral P. Liposomal Bupivacaine Injection for Analgesia During Minimally Invasive Supracervical Hysterectomy. JSLS 2022; 26:JSLS.2022.00008. [PMID: 35815323 PMCID: PMC9255262 DOI: 10.4293/jsls.2022.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the efficacy of intracervical injection of liposomal bupivacaine for postoperative pain control among women undergoing minimally invasive supracervical hysterectomy. Methods A randomized double-blinded placebo-controlled trial of intracervical injection of combination liposomal bupivacaine and bupivacaine for postoperative pain among patients undergoing laparoscopic and robotic supracervical hysterectomy. Patients were enrolled between October 1, 2018 and April 30, 2019. The primary outcome was pain at 12 hours postoperatively using a numeric rating scale from zero to 10. Pain scores were also recorded pre-operatively, immediately postoperatively, at 12, 24, and 48 hours postoperatively. The secondary outcome was the number of patients who required opioid analgesic medications up to 48 hours postoperatively. Results Sixty participants were randomized into the control (n = 30) and intervention (n = 30) groups. Pain scores were 1 and 1.75 (p = 0.89) immediately postoperatively, 3 and 3.5 (p = 0.85) at 12 hours, 3.5 and 5 (p = 0.22) at 24 hours, and 2.75 and 4 (p = 0.18) at 48 hours for the control and intervention groups, respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics (p = 0.37). From the 24 to 48 hours window, 6 and 8 patients in the control and intervention groups used narcotics (p = 0.74), respectively. Conclusion There was no statistically significant difference in pain scores between patients receiving combination liposomal bupivacaine and bupivacaine intracervical block and those receiving placebo in the first 48 hours after surgery. There was no difference in analgesic use between the two study groups.
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Affiliation(s)
- Mary Ann Son
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Shantel Jiggetts
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Amro Elfeky
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | | | - Michael Silver
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - David Herzog
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Sumit Saraf
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Pedram Bral
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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26
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Lawson EC, Hu R, Silver M, Greene JG. Administration of Recombinant Tissue Plasminogen Activator for Sulcal Artery Syndrome. Neurol Clin Pract 2022; 11:e901-e903. [PMID: 34992975 DOI: 10.1212/cpj.0000000000000995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
A 58-year-old man with history of left parietal lobe ischemic stroke, multifocal lacunar infarctions with residual mild right sided weakness, ongoing tobacco abuse, and hypertension presented to the emergency department with an initial complaint of right sided throbbing headache, right neck, arm, and leg pain that started acutely 3 hours prior. Patient denied new weakness or numbness from his baseline and was ambulatory. While undergoing triage, he acutely developed right arm and leg flaccid paralysis. Upon evaluation by the stroke team he was noted to have an NIHSS of 11. CT head demonstrated chronic infarctions, and CT angiogram head and neck did not show large vessel occlusion, dissection, or focal intracranial atherosclerosis. Initial screening labs included complete blood count with differential, glucose, and complete metabolic panel all within normal range. Patient was administered rTPA and admitted to the neurologic intensive care unit. MRI brain without gadolinium did not reveal an acute infarction, but showed known prior left superior middle cerebral artery division stroke and prior lacunar infarctions. On hospital day 1 there was subjective improvement in right hemibody weakness, but also new left sided sensory deficits. Examination was notable for 4-/5 right upper extremity strength, 5-/5 right lower extremity strength, nearly at baseline from prior ischemic stroke, except for increased right hand weakness. Sensory examination demonstrated new left sided diffuse loss to pain and temperature in the upper and lower extremity with bilaterally intact vibration and proprioception.
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Affiliation(s)
- Eric C Lawson
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ranliang Hu
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Michael Silver
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - James G Greene
- Department of Neurology (ECL, MS, JGG); and Department of Radiology and Imaging Sciences, Division of Neuroradiology (RH), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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27
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London V, Blitz MJ, Solmonovich R, Silver M, Minkoff H. Temporal Trend in SARS-CoV-2 Symptoms in Pregnant Women. Am J Perinatol 2021. [PMID: 34918329 DOI: 10.1055/s-0041-1739490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to examine temporal trends in the clinical presentation of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy. STUDY DESIGN This is a retrospective cohort study of pregnant women who were universally screened for SARS-CoV-2 and tested positive. This multi-center study of admissions to labor and delivery units in New York City and Long Island included all SARS-CoV-2-infected pregnant women admitted to labor and delivery units between April 10th and June 4th 2020. Six Northwell Health hospitals and Maimonides Medical Center were included in the study. The main measures of the study included patient reports of COVID-19 symptoms: fever, cough, chest pain, shortness of breath, nausea, vomiting, and intensive care unit (ICU) admissions. The main outcome measure was the percentage of all infected women who reported any of the above symptoms. RESULTS In total, 427 infected pregnant women were included in the study. There was a statistically significant decline in the percentage of patients presenting with any symptoms over the course of the study. In addition, disease severity, symptoms of fever, cough, and chest pain/shortness of breath also significantly declined over time, and no ICU admissions were noted after the third week of April. CONCLUSIONS There was a temporal shift away from symptomatic presentation in pregnant women diagnosed with SARS-CoV-2 over the course of the first months of the epidemic in New York. Further studies are necessary to elucidate the cause of this change in presentation among pregnant women, to determine whether this trend is also observed in other patient populations. KEY POINTS · Retrospective cohort review of 427 SARS-CoV-2-infected pregnant women admitted to labor and delivery units.. · A significant decline in the percentage of patients presenting with symptoms over time was noted.. · Further studies are necessary to elucidate the cause of this change in presentation.. · Theories for the noted trend: viral evolution, decreased viral inoculums, and prolonged polymerase chain reaction positivity..
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Affiliation(s)
- Viktoriya London
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Matthew J Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Division of Maternal-Fetal Medicine, Southside Hospital, Bay Shore, New York
| | - Rachel Solmonovich
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Michael Silver
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York.,Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York
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Simon S, Li R, Andrade JA, Tharian B, Silver M, Cox DV, Gonzalez D, Mayer AM, Fu LH, Truong J, Figueroa N, Ghitan M, Chapnick E, Lin YS. 709. Risk Factors for Candida auris Candidemia: Results from a Multicenter Case-Control Study. Open Forum Infect Dis 2021. [PMCID: PMC8644624 DOI: 10.1093/ofid/ofab466.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The emergence of Candida auris as a global pathogen has been described as a serious global threat by the CDC. It has caused outbreaks in healthcare settings as it is transmissible between patients. The risk factors for candidemia caused by C. auris may be different than candidemia caused by other Candida spp. Methods We performed a multicenter, retrospective case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients with at least one positive blood culture for Candida spp who were started empirically on an antifungal within 24 hours of blood culture positivity were included in the study. Subsequent cases in the same patient were excluded unless separated by at least 90 days from the initial case. Similar variables such as antibiotics and antifungals within the same drug class were compressed into one variable. Variables with a p-value ≤ 0.05 on univariate analysis were entered into a multivariable analysis with a p-value ≤ 0.05 considered to be statistically significant. Results 84 cases of C. auris candidemia and 105 cases of candidemia caused by other Candida spp were included in the analysis. The most common species of other Candida spp was C. glabrata (N=33, 31.7%) followed by C. albicans (N=32, 30.4%). In the multivariable model, the strongest risk factor for C. auris candidemia was prior infection or colonization with C. auris (aOR 17.5; 95% CI, 1.60-192.93; P = 0.019) followed by prior infection or colonization with multidrug-resistant bacteria (aOR 6.97; 95% CI 1.49-32.74, P = 0.014). A history of peripheral vascular disease (PVD) (aOR 7.78; 95% CI 1.34-45.34, P = 0.023), cerebrovascular disease (CVA) (aOR 4.24; 95% CI 1.18-15.20, P = 0.027) and hemiplegia (aOR 6.43; 95% CI 1.19-34.85, P = 0.031) were also statistically significant. These risk factors remained significant analyzing only patients without any history of C. auris. Conclusion These data suggest that in hospitalized patients with candidemia, a history of colonization or infection with C. auris, prior infection or colonization with multidrug-resistant bacteria, as well as a history of PVD, CVA, and hemiplegia are associated with C. auris candidemia. Disclosures Samuel Simon, PharmD, Accelerate Diagnostics (Employee)
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Affiliation(s)
| | - Rosanna Li
- Maimonides Medical Center, Brooklyn, New York
| | | | | | | | | | | | | | - Lung H Fu
- Maimonides Medical Center, Brooklyn, New York
| | - James Truong
- The Brooklyn Hospital Center, Brooklyn, New York
| | | | | | | | - Yu Shia Lin
- Maimonides Medical Center, Brooklyn, New York
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Sandozi A, Lee J, Shpeen BH, Silver M, Buford KE, Polland A. Availability of Lactation Accommodation Information for Urology Residency Programs. Urology 2021; 162:99-104. [PMID: 34757050 DOI: 10.1016/j.urology.2021.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess whether urology residency programs publish information about lactation accommodations online. Although residencies are required to provide lactation accommodations, there is limited data on whether programs disclose this information. MATERIALS AND METHODS Webpages of U.S. urology residency programs were assessed for presence of information about lactation. Program characteristics were noted, as were mentions of resident wellness and diversity. Associations between program characteristics and published lactation accommodations were determined by univariate analysis and development of a multivariate logistic regression model. RESULTS Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution's website There was great variability in ease of accessing information and of quality of information available. Information was most commonly on graduate medical education websites (28.3%) followed by human resources (24.1%), press releases (7.6%), or other sections (11.0%), and least likely to be found on urology residency websites (1.4%). Programs with lactation accommodations anywhere on the institution website were more likely to be larger (p < 0.001), university-based (p < 0.001), and to publish information about resident wellness (p < 0.001), diversity and inclusion (p < 0.001). On multivariate analysis, only university-based setting presence of wellness information were predictors of availability of lactation accommodation information. CONCLUSION Lactation accommodation information is usually not available on urology residency websites and most online information is found elsewhere. Predictors of publishing lactation accommodation information were university-based setting and information about resident wellness. Efforts to recruit and retain female urologists should include making this information more easily accessible.
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Ibrahim M, Pu Q, Silver M, Pu S, Meghpara M, Sebastian A, Almadani M, Rhee R. Cases of Late Open Conversion After Failed Endovascular Aneurysm Repair is Increasing and its 30-Day Mortality Remains High. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zu K, Arunachalam A, Hohlbauch A, Silver M, Annavarapu S, Pietanza M. P63.08 Real-World Utilization of Immune Checkpoint Inhibitors in Extensive Stage Small Cell Lung Cancer in Community Settings. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Silver M, Goldberg J. Prevalence of Obstructive Sleep Apnea Risk according to the STOP-BANG Questionnaire in an Oral Surgery Office-based Anesthesia Patient Population. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kotamarti S, Teper E, Silver D, Silver M, Schulman A. MP13-19 THE CONTEMPORARY PROFILE OF OCTOGENARIANS UNDERGOING RADICAL CYSTECTOMY IN THE UNITED STATES. J Urol 2021. [DOI: 10.1097/ju.0000000000001994.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chaudhuri MA, Lucas JM, Chandra M, Silver M. N-Methyl-D-Aspartate Receptor-Negative Autoimmune Encephalitis in a Patient With an Ovarian Teratoma and an Associated Novel Cerebrospinal Fluid Autoantibody. Cureus 2021; 13:e16334. [PMID: 34306894 PMCID: PMC8279908 DOI: 10.7759/cureus.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Autoimmune encephalitis is most commonly caused by autoantibodies against N-methyl-D-aspartate (NMDA) receptors, and the malignancy most often associated with anti-NMDA receptor autoimmune encephalitis is an ovarian teratoma. Here, we describe a case of autoimmune encephalitis caused by a newly discovered cerebrospinal fluid autoantibody that has not been previously described and is not anti-NMDA receptor-mediated, which has been associated with an ovarian teratoma. It was successfully treated with high-dose corticosteroids and plasmapheresis followed by rituximab and chemotherapy (paclitaxel, ifosfamide, and cisplatin) for her teratoma.
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Affiliation(s)
- Munir A Chaudhuri
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Jason M Lucas
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Mona Chandra
- Psychology, The Chicago School of Professional Psychology, Chicago, USA
| | - Michael Silver
- Department of Neurology, Emory University School of Medicine, Atlanta, USA
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Persad V, McLaren R, Joslin-Roher S, Narayanamoorthy S, Silver M, Minkoff H. The effect of distraction on the quality of patient handoff: a randomized study. Int J Qual Health Care 2021; 33:6153900. [PMID: 33647103 DOI: 10.1093/intqhc/mzab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The number of patient handoffs has increased in recent years. In addition, technology has advanced in the medical field, leading to most providers carrying smartphones at work. Little is known about the effect of mobile devices and quality of patient handoffs. The objective of this study was to determine whether distraction affects the quality of sign-out among obstetrical providers. DESIGN A randomized, prospective study was conducted. SETTING Hospital. PARTICIPANTS INTERVENTION Obstetrical providers listened to a recorded sign-out vignette. Provider groups either were or were not exposed to a distraction while listening to the vignette. All providers had been told that they would be participating in a trial of two methods of sign-out, although in actuality they were all assigned to a single method. In the distraction arm, the participants were exposed to a 'distracting event' (a phone ring, which was answered by the proctor and followed by a brief conversation) that occurred midway through the vignette. MAIN OUTCOME MEASURE Providers answered a 14-question survey testing recall of facts included in the vignette. The results of each group were analyzed using Fisher's exact test and Student's t-test. RESULTS Eighty-eight providers were randomized, 44 in the distraction group and 44 in the non-distracted group. The average scores on the survey were similar between groups (11.0 and 10.8, P = 0.57). In addition, the average scores for questions that occurred after the distraction did not differ between the distracted and non-distracted groups (6.4 vs 6.2, P = 0.42). CONCLUSIONS We observed that a phone ring and brief response did not affect the obstetrical providers' recall of details of a standardized sign-out. More studies are warranted to determine if more frequent or longer distractions would change results.
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Affiliation(s)
- Vashisht Persad
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - Rodney McLaren
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th Street, Brooklyn, NY 11219, USA
| | - Sophia Joslin-Roher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - Sujatha Narayanamoorthy
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Howard Minkoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th Street, Brooklyn, NY 11219, USA.,Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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Dove D, Fassassi C, Davis A, Drapkin J, Butt M, Hossain R, Kabariti S, Likourezos A, Gohel A, Favale P, Silver M, Marshall J, Motov S. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med 2021; 78:779-787. [PMID: 34226073 DOI: 10.1016/j.annemergmed.2021.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE We aimed to assess and compare the analgesic efficacies and adverse effects of ketamine administered through a breath-actuated nebulizer at 3 different dosing regimens for emergency department patients presenting with acute and chronic painful conditions. METHODS This was a prospective, randomized, double-blinded trial comparing 3 doses of nebulized ketamine (0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg) administered through breath-actuated nebulizer in adult emergency department patients aged 18 years and older with moderate to severe acute and chronic pain. The primary outcome included the difference in pain scores on an 11-point numeric rating scale between all 3 groups at 30 minutes. Secondary outcomes included the need for rescue analgesia (additional doses of nebulized ketamine or intravenous morphine) and adverse events in each group at 30 and 60 minutes. RESULTS We enrolled 120 subjects (40 per group). The difference in mean pain scores at 30 minutes between the 0.75 mg/kg and 1 mg/kg groups was 0.25 (95% confidence interval [CI] 1.28 to 1.78); between the 1 mg/kg and 1.5 mg/kg groups was -0.225 (95% CI -1.76 to 1.31); and between the 0.75 mg/kg and 1.5 mg/kg groups was 0.025 (95% CI -1.51 to 1.56). No clinically concerning changes in vital signs occurred. No serious adverse events occurred in any of the groups. CONCLUSION We found no difference between all 3 doses of ketamine administered through breath-actuated nebulizer for short-term treatment of moderate to severe pain in the emergency department.
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Affiliation(s)
- Daniel Dove
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Catsim Fassassi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Ashley Davis
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Jefferson Drapkin
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
| | - Mahlaqa Butt
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Rukhsana Hossain
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Sarah Kabariti
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | | | - Ankit Gohel
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY
| | - Patrizia Favale
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY
| | - Michael Silver
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - John Marshall
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
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Abstract
Background: Pneumomediastinum and pneumothorax are complications which may be associated
with barotrauma in mechanically ventilated patients. The current literature
demonstrates unclear outcomes regarding barotrauma in critically ill
patients with severe COVID-19. The purpose of this study was to examine the
incidence of barotrauma in patients with severe COVID-19 pneumonia and its
influence on survival. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5,
2020, with follow-up through June 18, 2020, encompassing critically ill
intubated patients admitted for COVID-19 pneumonia at an academic tertiary
care hospital in Brooklyn, New York. Critically ill patients with
pneumomediastinum, pneumothorax, or both (n = 75) were compared to those
without evidence of barotrauma (n = 206). Clinical characteristics and
short-term patient outcomes were analyzed. Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable
analysis, factors associated with increased 30-day mortality were elevated
age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma
(1.417 [1.040-1.931], P = 0.027), and renal dysfunction
(1.602 [1.055-2.432], P = 0.027). Protective factors were
administration of remdesivir (0.479 [0.321-0.714], P <
0.001) and receipt of steroids (0.488 [0.370-0.643], P <
0.001). Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with
COVID-19 pneumonia and was found to be an independent risk factor for 30-day
mortality.
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Affiliation(s)
- Victor P Gazivoda
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Mudathir Ibrahim
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron Kangas-Dick
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Arony Sun
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Division of Biostatistics, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Ory Wiesel
- Department of Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA.,Division of Thoracic Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
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Levitan D, London V, McLaren RA, Mann JD, Cheng K, Silver M, Balhotra KS, McCalla S, Loukeris K. Histologic and Immunohistochemical Evaluation of 65 Placentas From Women With Polymerase Chain Reaction-Proven Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection. Arch Pathol Lab Med 2021; 145:648-656. [PMID: 33596304 DOI: 10.5858/arpa.2020-0793-sa] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT.— Coronavirus disease 2019 (COVID-19) has been shown to have effects outside of the respiratory system. Placental pathology in the setting of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a topic of great interest because earlier studies have shown mixed results. OBJECTIVE.— To ascertain whether maternal SARS-CoV-2 infection is associated with any specific placental histopathology, and to evaluate the virus's propensity for direct placental involvement. DESIGN.— Placentas from 65 women with polymerase chain reaction-proven SARS-CoV-2 infection underwent histologic evaluation using Amsterdam consensus group criteria and terminology. Another 85 placentas from women without SARS-CoV-2 constituted the negative control group. A total of 64 of the placentas from the SARS-CoV-2-positive group underwent immunohistochemical staining for SARS-CoV-2 nucleocapsid protein. RESULTS.— Pathologic findings were divided into maternal vascular malperfusion, fetal vascular malperfusion, chronic inflammatory lesions, amniotic fluid infection sequence, increased perivillous fibrin, intervillous thrombi, increased subchorionic fibrin, meconium-laden macrophages (M-LMs) within fetal membranes, and chorangiosis. There was no statistically significant difference in prevalence of any specific placental histopathology between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. There was no immunohistochemical evidence of SARS-CoV-2 virus in any of the 64 placentas that underwent staining for viral nucleocapsid protein. CONCLUSIONS.— Our study results and a literature review suggest that there is no characteristic histopathology in most placentas from women with SARS-CoV-2 infection. Likewise, direct placental involvement by SARS-CoV-2 is a rare event.
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Affiliation(s)
- Daniel Levitan
- From the Department of Pathology & Laboratory Medicine (Levitan, Loukeris), at Maimonides Medical Center, Brooklyn, New York.,The Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York (Levitan, Loukeris)
| | - Viktoriya London
- Division of Maternal Fetal Medicine (London, McLaren), at Maimonides Medical Center, Brooklyn, New York.,Department of Obstetrics & Gynecology (London, McLaren, Balhotra, McCalla), at Maimonides Medical Center, Brooklyn, New York
| | - Rodney A McLaren
- Division of Maternal Fetal Medicine (London, McLaren), at Maimonides Medical Center, Brooklyn, New York.,Department of Obstetrics & Gynecology (London, McLaren, Balhotra, McCalla), at Maimonides Medical Center, Brooklyn, New York
| | | | - Ke Cheng
- HistoWiz Inc, Brooklyn, New York (Mann, Cheng)
| | - Michael Silver
- Office of Research Administration (Silver), at Maimonides Medical Center, Brooklyn, New York
| | - Kimen Singh Balhotra
- Department of Obstetrics & Gynecology (London, McLaren, Balhotra, McCalla), at Maimonides Medical Center, Brooklyn, New York
| | - Sandra McCalla
- Department of Obstetrics & Gynecology (London, McLaren, Balhotra, McCalla), at Maimonides Medical Center, Brooklyn, New York
| | - Kristina Loukeris
- From the Department of Pathology & Laboratory Medicine (Levitan, Loukeris), at Maimonides Medical Center, Brooklyn, New York.,The Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York (Levitan, Loukeris)
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Lax Y, Brown SN, Silver M, Brown NM. Associations Between Participation in After-School Activities, Attention-Deficit/Hyperactivity Disorder Severity, and School Functioning. J Dev Behav Pediatr 2021; 42:257-263. [PMID: 33394836 DOI: 10.1097/dbp.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association between after-school activity (ASA) participation, attention-deficit/hyperactivity disorder (ADHD) severity, and school functioning among children with ADHD. METHODS A cross-sectional study was conducted using data from the 2016 National Survey of Children's Health on ADHD severity, ASAs and 2 domains of school functioning among children with ADHD: missed days from school and calls home from school. RESULTS Of 4,049 children with ADHD (weighted N = 5,010,662), 71.8% participated in at least 1 ASA. In multivariable regression analyses, ASA participation was associated with lower odds of moderate-to-severe ADHD [adjusted odds ratio (aOR): 0.62, 95% confidence interval (CI), 0.46-0.85] and lower odds of missed school days (aOR 0.55, 95% CI, 0.41-0.74). We did not find significant associations with calls home from school (aOR 0.79, 95% CI, 0.59-1.07). CONCLUSION After-school activity participation is associated with decreased ADHD severity and reduced school absenteeism. Efforts to optimize ADHD outcomes should consider engaging children and adolescents in ASAs.
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Affiliation(s)
- Yonit Lax
- Division of General Pediatrics, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY
| | | | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY
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Mendoza R, Silver M, Zuretti AR, Christian M, Das B, Norin AJ, Borgen P, Libien J, Bluth MH. Correlation of Automated Chemiluminescent Method with Enzyme-Linked Immunosorbent Assay (ELISA) Antibody Titers in Convalescent COVID-19 Plasma Samples: Development of Rapid, Cost-Effective Semi-Quantitative Diagnostic Methods. J Blood Med 2021; 12:157-164. [PMID: 33762863 PMCID: PMC7982562 DOI: 10.2147/jbm.s296730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background We investigated the utility of an automated chemiluminescent SARS-CoV-2 IgG antibody assay platform in quantifying the amount of binding antibodies present in donated convalescent plasma. Methods A total of 179 convalescent plasma units were analyzed for the presence of SARS-CoV-2 IgG antibodies using the Beckman-Coulter chemiluminescent immunoassay (CLIA) platform. The equipment-derived numerical values (S/Co ratio) were recorded. Aliquots from the same units were subjected to enzyme-linked immunosorbent assay (ELISA) that detects IgG antibodies against the receptor-binding domain (RBD) of the SARS-CoV-2 S1 protein. The relationship between ELISA titers and CLIA S/Co values was analyzed using linear regression and receiver operating characteristics (ROC) curve. Results Twenty-one samples (11.7%) had S/Co values of less than 1.0 and were deemed negative for antibodies and convalescent plasma had S/Co values between >1.0 and 5.0 (70/179, 39.1%). Fifteen units (8.4%) had negative ELISA titer. The majority of the units (95/179. 53.1%) had titers ≥1:1024. The sensitivities of ELISA to CLIA were comparable (90.5% vs 88.3%, respectively; p=0.18). There was positive linear correlation between CLIA S/Co values and ELISA IgG titer (Rho = 0.75; Spearman’s rank = 0.82, p-value = <0.0001). The agreement between the two methods was fair, with a κ index of 0.2741. Using the ROC analysis, we identified a CLIA S/Co cutoff value of 8.2, which gives a sensitivity of 90% and a specificity of 82% in predicting a titer dilution of ≥1:1024. Conclusion The utility of automated antibody detection systems can be extended from simply a screening method to a semi-quantitative and quantitative functional antibody analysis. CLIA S/Co values can be used to reliably estimate the ELISA antibody titer. Incorporation of chemiluminescent-based methods can provide rapid, cost-effective means of identifying anti-SARS-CoV-2 antibody titers in donated plasma for use in the treatment of COVID-19 infection.
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Affiliation(s)
- Rachelle Mendoza
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael Silver
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Alejandro R Zuretti
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Pathology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Manan Christian
- Department of Pathology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ballabh Das
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Allen J Norin
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick Borgen
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jenny Libien
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Pathology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Martin H Bluth
- Department of Pathology, Maimonides Medical Center, Brooklyn, NY, USA
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Kotamarti S, Silver M, Wood A, Teper E, Silver D, Schulman A. Do females have worse surgical outcomes after radical cystectomy? Impact of gender on 30-day complications in a national cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
402 Background:: Men have higher rates of bladder cancer and are more likely to undergo cystectomy than women, yet women seem to have worse oncologic outcomes. This is attributed to biologic factors including adverse histologic variants and social factors including delay in diagnosis. There is early evidence that women also have worse surgical outcomes. We further examined the role of gender in 30-day perioperative outcomes following radical cystectomies in a national cohort. Methods: We examined the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2016. The database was searched for CPT codes reflecting radical cystectomy and a diagnosis of “cancer of the bladder.” Frailty was estimated by the modified frailty index (functional status, diabetes, chronic obstructive pulmonary disorder, history of chronic heart failure, and hypertension requiring medication.) To compare demographic and perioperative characteristics between genders, Chi-Square analyses were performed for categorical variables, student’s t test to compare averages, and the Wilcoxon rank sum test for operative time and length of stay (LOS). Results: 4,681 radical cystectomies were identified including 842 (18.0%) females. Of the female cohort, average age was 68.6 (+/-11.2 years), 77.3% was Caucasian and 278 (33%) had a BMI of at least 30. There were no differences appreciated between genders with regards to age, average ASA score, frailty, or minimally-invasive approach (all p=NS). Compared to males, female gender was associated with longer operative time (350 vs. 336 min, p<0.009), length of stay (LOS) (8 vs 7, p<0.001) and lower rates of discharge to home (79.9% vs 87.0%, p<0.0001). Reoperation (4.8% vs. 6.0%), readmission (22.2% vs 20.6%), and death within 30 days (1.9% vs. 2.0%) were similar. Clavien 3 or greater was also similar among gender (Table). Conclusions: Female patients comprise a minority of radical cystectomies with slightly longer LOS and less home discharge than men, yet 30-day major complications, reoperation and mortality appear similar. [Table: see text]
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McLaren R, London V, Narayanamoorthy S, Atallah F, Silver M, Minkoff H. 755 Cesarean birth morbidity among women with SARS-CoV-2. Am J Obstet Gynecol 2021. [PMCID: PMC7848528 DOI: 10.1016/j.ajog.2020.12.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Randhawa G, Syed KA, Singh K, Kundal SV, Oli S, Silver M, Syed SA, Suban Na Ayutthaya T, Williams S, Lodato ZL, Rozvadovskiy V, Kamholz S, Wolf L. The relationship between obesity, hemoglobin A1c and the severity of COVID-19 at an urban tertiary care center in New York City: a retrospective cohort study. BMJ Open 2021; 11:e044526. [PMID: 33518528 PMCID: PMC7852070 DOI: 10.1136/bmjopen-2020-044526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN Retrospective cohort study. SETTING Urban tertiary care center in New York City. PARTICIPANTS 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.
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Affiliation(s)
- Gurchetan Randhawa
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kunzah A Syed
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kavish Singh
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sanchit V Kundal
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sharad Oli
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Michael Silver
- Department of Research, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sumrah A Syed
- Department of Family Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, New York, USA
| | | | | | - Zachary L Lodato
- NYIT College of Osteopathic Medicine, Old Westbury, New York, USA
| | | | - Stephan Kamholz
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Lawrence Wolf
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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Mishra S, Choueka M, Wang Q, Hu C, Visone S, Silver M, Stein EG, Levine SR, Wang QT. Intracranial Hemorrhage in COVID-19 Patients. J Stroke Cerebrovasc Dis 2021; 30:105603. [PMID: 33484980 PMCID: PMC7831866 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. Methods Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed. Results Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively. Conclusions COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.
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Affiliation(s)
- Sanskriti Mishra
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Murray Choueka
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Qiang Wang
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Chloe Hu
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Stephanie Visone
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Evan G Stein
- Department of Radiology, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Steven R Levine
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States.
| | - Qingliang T Wang
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Surgery/Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
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Gibbs R, Fu LH, Silver M, Lockerman ZS, Ghitan M, Chapnick E, Lin YS. 420. Diagnostic Utility of Chest CT scan for COVID-19, in the Early Stage of the Pandemic in Brooklyn, New York. Open Forum Infect Dis 2020. [PMCID: PMC7776889 DOI: 10.1093/ofid/ofaa439.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Diagnosis of coronavirus disease 2019 (COVID-19) in the early weeks of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in New York City posed unique challenges. Due to inadequate testing availability and long turnaround times, decisions on which patients to isolate were problematic. With sensitivity comparable to reverse transcription polymerase chain reaction (RT-PCR), the absence of ground glass opacities (GGOs) on chest CT scan was useful to rule out COVID-19. We evaluated the specificity of chest CT scan findings for COVID-19 along with other clinical and laboratory findings. Methods A retrospective chart review was done of 182 adult patients who were tested for SARS-CoV-2 by RT-PCR and underwent a chest CT scan while admitted to Maimonides Medical Center between March 1 to 23, 2020. Cases were defined as those with a positive RT-PCR result or who were treated for COVID-19. Negative cases were defined as those with negative RT-PCR and an alternative diagnosis confirmed by an ID physician. Beyond March 23, almost all newly admitted patients were isolated. Results There were 111 COVID-19 positive and 71 COVID-19 negative patients. Of the COVID-19 patients, 61% were male and 39% female, 56% white, 20% Hispanic, 14% black, 9% Asian, 36% Jewish, 35% had diabetes mellitus (DM), 50% had hypertension and 42% had cardiovascular disease. Clinical symptoms, signs, and laboratory values for COVID-19 positive and negative groups were not significantly different. COVID-19 patients had significantly higher BMI (p = 0.001). On chest CT scan, bilateral or unilateral, peripheral distribution and lower lobar GGOs were over 80% specific for COVID-19. The frequency of GGOs was significantly higher when chest CT scans were done during the second week of illness compared to the first week (p = 0.0195). Jewish patients were associated with higher rates of death (p = 0.0475) and underlying DM was associated with higher rates of ARDS, AKI, intubation, ICU admission and death (p < 0.05) compared to other demographic and comorbid groups. Conclusion Chest CT scan is an important component in the diagnostic process for patients with suspected COVID-19 infection, especially during the second week of symptoms. The findings may aid clinical decisions in the setting of a second surge of SARS-CoV-2. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Rachel Gibbs
- Ben Gurion University of the Negev, Wellesley, Massachusetts
| | - Lung H Fu
- Maimonides Medical Center, brooklyn, New York
| | | | | | | | | | - Yu Shia Lin
- Maimonides Medical Center, brooklyn, New York
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Fassassi C, Dove D, Davis A, Butt M, Masoudi A, Drapkin J, Gohel A, Silver M, Likourezos A, Motov S. Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. Am J Emerg Med 2020; 46:579-584. [PMID: 33341323 DOI: 10.1016/j.ajem.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Previous research demonstrated that administration of Morphine Sulfate Immediate Release (MSIR) results in similar analgesic efficacy to Oxycodone but with significantly lesser degrees of euphoria and reward. The purpose of this study sit to investigate if MSIR combined with Acetaminophen can serve as an opioid analgesic alternative to Oxycodone combined with acetaminophen (Percocet) for acute pain in the Emergency Department (ED). METHODS A prospective, randomized, double-blind trial of ED patients aged 18 to 64 years presenting with moderate to severe acute pain as defined by an 11-point numeric rating scale (NRS) with an initial score of ≥5 (0 = no pain and 10 = very severe pain). Patients were randomized to receive either 15 mg MSIR combined with 650 mg of Acetaminophen or 10 mg Oxycodone combined with 650 mg Acetaminophen. Patients were assessed at baseline, 30, 45 and 60 min. The primary outcome was reduction in pain at 60 min. Secondary outcomes include drug likeability and adverse events. RESULTS 80 patients were enrolled in the study (40 per group). Demographic characteristics were similar between the groups (P > 0.05). Mean NRS pain scores at baseline were 8.44 for the MSIR group and 8.53 for the Percocet group (P = 0.788). Mean pain scores decreased over time but remained similar between the groups: 30 min (6.03 vs. 6.43; P = 0.453), 45 min (5.31 vs. 5.48; P = 0.779), and 60 min (4.22 vs. 4.87; P = 0.346). Reduction in mean NRS pain scores were statistically significant from baseline to 30, 45 and 60 min within each group (P < 0.0001 at each time point for both groups). The largest NRS mean difference was from baseline to 60 min: 4.2 (95% CI: 3.43 to 5.01) for MSIR group and 3.61 (95% CI: 2.79 to 4.43) for Percocet group. No clinically significant changes or any serious adverse events were observed in either group. CONCLUSION MSIR provides similar analgesic efficacy as Percocet for short-term pain relief in the ED, similar rates of nausea/vomiting, and lower rates of likeability of the drug.
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Affiliation(s)
- Catsim Fassassi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Daniel Dove
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ashley Davis
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mahlaqa Butt
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aidin Masoudi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jefferson Drapkin
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Ankit Gohel
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Antonios Likourezos
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Byrne K, Mukerji A, Yang E, Levi D, Silver M. Visual cortical GABA and depth of amblyopia are negatively correlated. J Vis 2020. [DOI: 10.1167/jov.20.11.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bowen J, Theiss J, Silver M. Spatial Attention within Dynamic Receptive Field Pooling Arrays: Implications for Visual Crowding and Convolutional Neural Networks. J Vis 2020. [DOI: 10.1167/jov.20.11.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pasternack JB, Ciminero ML, Silver M, Chang J, Simon RJ, Kang KK. Effect of weekend admission on geriatric hip fractures. World J Orthop 2020; 11:391-399. [PMID: 32999859 PMCID: PMC7507075 DOI: 10.5312/wjo.v11.i9.391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented. With respect to hip fractures, however, there is no consensus about the presence of a so-called “weekend effect”. This study sought to determine the effects, if any, of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital. It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.
AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.
METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted. Two cohorts were compared: patients who arrived at the emergency department on a weekend, and those that arrived at the emergency department on a weekday. Primary outcome measures included mortality rate, complication rate, transfusion rate, and length of stay. Secondary outcome measures included time from emergency department arrival to surgery, time from emergency department arrival to medical optimization, and time from medical optimization to surgery.
RESULTS There were no statistically significant differences in length of stay (P = 0.2734), transfusion rate (P = 0.9325), or mortality rate (P = 0.3460) between the weekend and weekday cohorts. Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday (13.3% vs 8.3%; P = 0.044). Time from emergency department arrival to medical optimization (22.7 h vs 20.0 h; P = 0.0015), time from medical optimization to surgery (13.9 h vs 10.8 h; P = 0.0172), and time from emergency department arrival to surgery (42.7 h vs 32.5 h; P < 0.0001) were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.
CONCLUSION This study provided insight into the “weekend effect” for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.
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Affiliation(s)
- Jordan B Pasternack
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Matthew L Ciminero
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Michael Silver
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Joseph Chang
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Ronald J Simon
- Department of Trauma Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
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Martinez M, Silver M, Schulman A. Letter to the Editor in Response to: COVID-19: Magnifying the Effect of Health Disparities. J Gen Intern Med 2020; 35:2780. [PMID: 32666491 PMCID: PMC7360349 DOI: 10.1007/s11606-020-06038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mariela Martinez
- Division of Urology, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, Brooklyn, NY, USA
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